Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your medical history and would like to explain that a limb amputation may become an alternative to seriously consider and almost inevitable only if any of the following is present:

- significant necrosis of weight-bearing portions of the foot,
- uncorrectable flexion contracture,
- paresis of the extremity,
- refractory ischemic rest pain,
- sepsis

So, in other words, amputation of the limb would be preferred only in the case of an obvious irreversible limb ischemia with extensive necrosis or gangrene.

In all the other cases, a re-attempt for new revascularization procedures after a careful review of the limb blood flow status would be encouraged.

The fact that you have had repeated attempts of revacularization procedures (endovascular stents and graphs) means that there are potential risk factors that adversely affect their durability.

In such case, a careful review of all possible risk factors (diabetes, hypertension, dyslipidemia, smoking, several systemic inflammatory disease [connective tissue diseases, hyperhomocysteinemia, etc.], several coagulopathies, etc. should be done and prompt underlying correcting intervention utilized.

For femoro-popliteal stenosis, paclitaxel-coated balloons have been shown promisin in recent clinical trials, meanwhile for infra-popliteal lesions the situation remains unclear.

I recommend discussing with your attending vascular specialist on the above mentioned issues to find the possible available alternatives for a new revascularization attenpt, as the signs of a clear severe ischemia are not yet obvious and a therapy optimization could be beneficial.

Hope you will find this answer of some help!

In case of any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri

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